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Objective: To determine if weight gain in college subjects is associated with meal frequency, breakfast consumption, breakfast type, and alcohol intake over one year of college. Secondary aims were to determine whether BMI and body fat percent are associated with breakfast consumption and type as well as meal frequency. Design: A longitudinal observational study. Health history, work schedule and sleep patterns were recorded. Subjects fasted overnight and height, weight, skin fold measurements, waist, and hip measurements were taken. Two seven day food and activity records were self recorded in September 2005 and in April of 2006. Subjects: One-thousand fifty college students enrolled in freshman level foods and nutrition or personal health courses in fall 2005 were invited to participate in the study; 507 agreed to participate in the study. Main Outcome Measures: Weight change, meal frequency, number of breakfasts per week, breakfast type, and amount of alcohol consumed were analyzed. Weight change by breakfast category was also analyzed. Statistical analyses: Diet records were entered into Nutritionist Pro™ for nutrient analysis. Associations between weight change and meal frequency, breakfast consumption, and alcohol intake in college students were analyzed using independent t-test and analysis of variance (ANOVA). Results: Two-hundred and thirty subjects completed the study. Subjects ate more breakfasts per week in September (148.5 ± 32.5) compared to April (149.6 ± 32.5, p > .05). Non-breakfast eaters gained slightly more weight than breakfast eaters (p = .099). Similar results were found for meal frequency and weight change. Those who consumed more meals per day gained less weight compared to those who ate 4 or fewer meals per day (p = .206). Non drinkers gained significantly more weight than heavy drinkers (p = .004). Conclusion: Although significant associations between breakfast consumption, meal frequency and weight change were not found, results from this study suggest that increasing breakfast consumption as well as meal frequency may be beneficial in reducing the amount of weight gained over time. Although non-drinkers gained significantly more weight than heavy drinkers, more studies are warranted to investigate this finding. Application: This study strengthens the literature on meal frequency and breakfast consumption as they are associated with changes in body weight. The study was also the first of our knowledge to assess these associations in a college setting. Based on these findings, more studies are warranted to determine whether the associations between weight changes and meal frequency as well as breakfast consumption and breakfast type are strongly correlated when a larger and more diverse population base is used. / Master of Science

This thesis includes two publications originating from the Leipzig School Nutrition Study. Data from the first publication show associations of weekday eating habits with the prevalence of overweight in 4th- and 6th- to 8th-grade students in a city of about 600,000 inhabitants in Germany. Unsteady breakfast habits, skipping breakfast, or not having lunch during the school day were positively associated with the prevalence of being overweight. The associations with having breakfast persist after controlling for known risk factors like parental overweight and SES [28]. Having two breakfasts resulted in even stronger associations. The finding that children with a low SES skipped breakfast more often confirms our hypothesis as well as previous research. In the second paper, we investigated predictors of school lunch participation and reasons for non-participation, i.e., possible intervention targets in 1215 German schoolchildren. The main finding of this study is that school lunch participation is primarily associated with family factors (migration background, parental overweight, SES, families with many children). The most stated reasons for nonparticipation were school-and lunch-related factors like taste, time constraints, and pricing. For children, time constraints were as important as pricing whereas parents reported pricing was as crucial a reason as the taste for nonparticipation. In line, one-third of the parents stated their child would be more likely to participate if school lunch was free of charge. Therefore, our data stress school-and lunch-related factors as an important opportunity to foster school lunch utilization.:Contents Abbreviations ............................................................................................................ 1 Introduction ............................................................................................................... 2 Background............................................................................................................ 2 School meals ......................................................................................................... 3 Relevance of the topic ........................................................................................... 5 Leipzig School Nutrition study................................................................................ 7 Research questions ............................................................................................... 9 Publications - manuscripts ...................................................................................... 10 Summary ................................................................................................................ 12 References ............................................................................................................. 18 Spezifizierung des eigenen wissenschaftlichen Beitrags ........................................... I Selbstständigkeitserklärung ...................................................................................... V Lebenslauf ............................................................................................................... VI Personalien ........................................................................................................... VI Akademischer Werdegang:................................................................................... VI Berufliche Tätigkeit: .............................................................................................. VI Publikationen .......................................................................................................... VII Danksagung ........................................................................................................... VIII

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Bakgrund En mer stillasittande livsstil med ett högre kaloriintag ökar riskerna för övervikt och andra metabola sjukdomar. För att förebygga och behandla dessa sjukdomar behöver vi bland annat förstå hur hungerkänslor regleras hos människan. Hur stor inverkan blodglukosnivåer har på hungerregleringen är dock omdiskuterat. Syfte Syftet med denna studie var att undersöka hur hungerkänslor och blodglukosnivåer förändras efter en måltid, jämfört med fasta. Kan den upplevda hungern påverkas genom periodisk fas-ta? Hur påverkar en invand måltidsrytm hungern? Hur påverkas hunger och blodglukos i för-väntan på en måltid? Metod Tolv friska testpersoner (7 män, 5 kvinnor) där sju stycken var vana vid periodisk fasta och fem inte var det, randomiserades in i två grupper där ena gruppen (Pi) fick äta en 600 kcal pizza medan den andra gruppen fick fasta (F). Blodglukosvärden och hungeruppskattningar registrerades var 30:e minut, förutom första värdet som registrerades 15 minuter innan pizzor-na serverades. Testpersonerna visste inte vilken grupp de skulle hamna i förrän 10 minuter innan pizzorna serverades. Resultat Fem timmar efter måltiden kunde ingen signifikant skillnad i blodglukossänkning observeras mellan grupperna. Hungern skiljde sig inte heller signifikant mellan grupperna. Endast Pi ökade dock signifikant i hunger (P = 0,05) jämfört med sina startvärden. Fastevana bidrog inte till en förbättrad hungerkontroll. Beskedet om vilken grupp testpersonerna skulle hamna i resulterade i att blodglukosnivåerna skiljde sig signifikant mellan grupperna (P = 0,05) när pizzorna serverades. Då sänktes blodglukosnivåerna hos Pi samtidigt som de höjdes hos F. Fyra av fem testpersoner i F och en testperson i Pi blev tydligt hungrigare vid tidpunkter då de vanligtvis brukade äta på. Slutsats Samband mellan absoluta blodglukosnivåer och hunger kunde inte hittas. Stark hunger kunde uppstå fastän dietär energi sannolikt fortfarande absorberades i tarmarna.Våra resultat indikerade därför att akut energitillgänglighet utgör en relativt liten del i den totala hungersignaleringen. En invand måltidsrytm såg ut att påverka hungern mer än vad måltiden i den här studien gjorde. Större fokus vid hungerreglering bör därför ligga på en re-gelbunden måltidsrytm. / Background The increasingly sedentary lifestyle of our society combined with a constantly rising caloric intake has elevated the risk of developing obesity and other metabolic diseases. There is a need to understand the underlying mechanisms of hunger regulation to effectively prevent and treat these diseases. The magnitude of which an active regulation of blood glucose has an influence on hunger regulation is rather controversial. Objective The objective of this study was to investigate how the changes in hunger and blood glucose levels may differ after a mixed meal compared to the fasting state. Research questions include: Does intermittent fasting reduce general hunger? How does an entrenched meal-pattern affect hunger? How does hunger and blood glucose change in anticipation of a meal? Method Twelve healthy subjects (7 men, 5 women), of which seven subjects regularly practiced intermittent fasting and the remaining five did not, were randomized into two groups, one group was eating pizza (Pi), and the other group was fasting (F). Blood glucose levels and hunger ratings were collected every 30 minutes, with exception of initial values that were collected 15 minutes prior to the serving of the pizzas. The subjects were unaware of which group they would be designated to until 10 minutes prior to the serving of the pizzas. Results Decline in blood glucose did not significantly differ between groups during the 5 hour window following the meal ingestion. Hunger ratings differed significantly between individuals but not between groups. However, only Pi had significantly elevated hunger ratings in the end of the test period compared to their initial ratings. In anticipation of the meal a significant change in blood glucose was observed between the groups (P = 0.05), where values dropped for Pi and rose for F. Four out of five subjects in F and one subject in Pi were considerably hungrier during time periods they reported as habitual eating occasion. Conclusion Correlations between absolute blood glucose levels and hunger could not be found. An equal rise in hunger appear regardless if subjects were fed or fasting, meaning significant hunger can appear although dietary energy still is absorbed into the blood stream. Thus our results indicate that the acute availability of dietary energy is only a relatively small part of the total hunger signaling process. A disrupted meal pattern seemed to affect hunger feelings more than the ingestion of the served meal. Thus we conclude that more research should focus on meal-pattern regulation to enable better hunger control.

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Given the high prevalence of childhood overweight, school-based programs aiming at nutritional behavior may be a good starting point for community-based interventions. Therefore, we investigated associations between school-related meal patterns and weight status in 1215 schoolchildren. Anthropometry was performed on-site in schools. Children reported their meal habits, and parents provided family-related information via questionnaires. Associations between nutritional behavior and weight status were estimated using hierarchical linear and logistic regression. Analyses were adjusted for age, socio–economic status, school type, migration background, and parental weight status. Having breakfast was associated with a lower BMI-SDS (βadj = −0.51, p = 0.004) and a lower risk of being overweight (ORadj = 0.30, p = 0.009), while having two breakfasts resulting in stronger associations (BMI-SDS: βadj = −0.66, p < 0.001; risk of overweight: ORadj = 0.22, p = 0.001). Likewise, children who regularly skipped breakfast on school days showed stronger associations (BMI-SDS: β = 0.49, p < 0.001; risk of overweight: OR = 3.29, p < 0.001) than children who skipped breakfast only occasionally (BMI-SDS: β = 0.43, p < 0.001; risk of overweight: OR = 2.72, p = 0.032). The associations persisted after controlling for parental SES and weight status. Therefore, our data confirm the school setting as a suitable starting point for community-based interventions and may underline the necessity of national programs providing free breakfast and lunch to children.

Intermittent fasting (IF) is a recently popularized meal timing strategy whereby individuals abstain continuously from any energy intake for 16 to 20 hours each day, subsequently condensing energy intake into a short period spanning 4 to 8 hours. We aimed to test the effects of intermittent fasting in 10 individuals with Type 2 Diabetes Mellitus in conjunction with recommendations to consume a high protein diet in a 6 to 8 week withdrawal study. This study consisted of three phases: baseline, intervention, and follow-up. During the 2-week baseline and intervention phases participants consumed meals at regular times. Biochemical, anthropometric, and physical activity measurements were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose and fasting duration on a daily basis, in addition to completing a remote food photography diary three times within each study phase. Despite the short duration of the intervention phase, intermittent fasting led to significant decreases in weight, BMI, morning SMBG, and overall reductions in waist circumference, C-reactive protein, energy intake, carbohydrate intake, and fat intake. There were significant variations between participants in response to intermittent fasting in respect to changes in lipids and insulin sensitivity, which could not be explained by baseline biochemical or anthropometric measures, fasting duration, energy intake, or physical activity. Upon cessation of intermittent fasting, biochemical changes regressed towards baseline values during the follow-up period. Intermittent fasting was well tolerated by most participants, and no severe adverse events were noted. Morning nausea was the most common complaint, which abruptly ceased when medication timing was changed.